Health Insurance and Autism

Individual or Family Health
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Health Insurance and Autism

Though nobody in the medical or scientific community knows exactly why, cases of childhood autism are on the rise. 10 years ago 1 in 2500 children suffered from this mystifying disorder, today it is 1 in 166, placing not only emotional but financial stress on millions of American families. Health Insurance traditionally has denied coverage for the treatments associated with the disorder.

Until recently Autism, a barely understood brain disorder that makes it difficult for children to communicate and form normal relationships with people - had generally been thought of as a learning disability. As such while Autistic child have been shown to benefit form such treatments as speech therapy or behavior modification - most health insurance companies would not pay for those treatments. Often placing an additional financial burden on families already suffering from the emotional stress that comes with the disorder. But this is beginning to change. Recently health insurance companies in Colorado recognized Autism as a congenital birth defect, and as such private health insurance companies have begun to reimburse covered families for Speech Therapy, Physical Therapy, and Occupational Therapy. Advocates for families of children with Autism are trying to get State and Federally run health insurance plans to follow suit. New York has recently passed similar legislation that does not discriminate against those with Autism as regards medical insurance.

Still the problem lies in that Autism is a very complex disorder, and determining what treatments are effective and can be defined as medically necessary and therefore subject to health insurance reimbursement can be challenging. As Lynn Hiltajczuk found out when she sought a treatment called Applied Behavior Analysis for her son Thomas who is Autistic.  Says Lynn, "Medically unnecessary" is a difficult thing to deal with - Does that mean he'll die if he doesn't have ABA? No. But it does mean he won't have a fulfilling life and be part of society." So Lynn and her husband keep on paying the almost 5000.00 a month for the treatments and continue to join with those fighting to get health insurance companies to cover the therapy.

While it may still be difficult to determine if a given therapy for autism will be covered by health insurance, the good news is that currently, seventeen states have insurance laws relating to medical coverage for autism, including 10 that require medical coverage for autism as part of the same laws that mandate medical coverage for mental illness. Six states, Georgia, Indiana, Kentucky, Maryland, New York, and Tennessee have laws specifically relating to health insurance coverage for Autism Spectrum Disorders

You can find out more about autism and health insurance coverage by logging on to www.autism-society.org